The candidate, Nishi Rawat, is a Critical Care physician and Assistant Professor in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins. Her goal is to become an independent investigator focused on advancing the field of quality improvement to improve the quality of health care delivered to Americans, while simultaneously reducing costs, with an emphasis on the application of information technology to evaluate performance, minimize waste and eliminate redundancies. The candidate's preliminary work as a co-investigator for two collaboratives to reduce ventilator-associated pneumonia (VAP) suggests that there is a strong drive to eliminate preventable harms such as VAP, but weak available methodologies and resources to do so. There is a dire need for an effective and inexpensive methodology to track the delivery of evidence-based interventions for the purpose of quality improvement. The proposed research intends to fill this measurement gap. In this proposal, she evaluates the utility of the sensor approach for measuring and improving quality of care, focusing on VAP prevention intervention performance. The aims propose: evaluate the utility of the sensor approach for measuring compliance with a VAP prevention intervention by comparing VAP process measure performance estimates captured by sensor technology to estimates obtained by traditional manual data collection (Aim 1); design and pilot a strategy to provide real-time feedback of sensor process measure compliance to providers (Aim 2); evaluate the impact of the sensor approach on VAP process measure compliance by comparing compliance before and after the implementation of the real-time feedback strategy (Aim 3). The proposed work could fundamentally change how healthcare monitors and reports important care interventions, and has the potential to make quality improvement more efficient, inexpensive and scalable. The candidate is uniquely qualified to undertake the proposed work. She is double-board certified in Critical Care and Emergency Medicine, and has completed a Patient Safety and Quality fellowship. She has led multiple local quality improvement initiatives, and worked to decrease ICU costs as part of a national task force, and is currently co-investigator of large national infection prevention collaborative. It isher determination, enthusiasm and strong work ethic which have enabled her to balance these research activities with a heavy clinical commitment. She now needs protected time for research and career development to become an independent investigator.